Association rule mining and prognostic stratification of 2-year longevity in octogenarians undergoing endovascular therapy for lower extremity arterial disease: Observational cohort study

Jing Yi Jhang*, I. Shiang Tzeng, Hsin Hua Chou, Shih Jung Jang, Chien An Hsieh, Yu Lin Ko, Hsuan Li Huang

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

10 Scopus citations

Abstract

Background: Two-year longevity is a crucial consideration in revascularization strategies for patients with symptomatic lower extremity arterial disease (LEAD). However, factors associated with 2-year longevity and risk stratification in octogenarians or nonagenarians have been underreported. Objective: This paper aims to investigate the associated variables and stratify the 2-year prognosis in older patients with LEAD. Methods: We performed logistic regression and association rule mining based on the Apriori algorithm to discover independent variables and validate their associations with 2-year longevity. Malnutrition, inflammation, and stroke factors were identified. C statistics and Kaplan-Meier analysis were used to assess the impact of different numbers of malnutrition, inflammation, and stroke factors on 2-year longevity. Results: We recruited a total of 232 octogenarians or nonagenarians (mean age 85 years, SD 4.2 years) treated with endovascular therapy. During the study period, 81 patients died, and 27 of those (33%) died from a cardiac origin within 2 years. Association rules analysis showed the interrelationships between 2-year longevity and the neutrophil-lymphocyte ratio (NLR) and nutritional status as determined by the Controlling Nutritional Status (CONUT) score or Geriatric Nutritional Risk Index (GNRI). The cut-off values of NLR, GNRI, and CONUT were ≥3.89, ≤90.3, and >3, respectively. The C statistics for the predictive power for 2-year longevity were similar between the CONUT score and the GNRI-based models (0.773 vs 0.760; P=.57). The Kaplan-Meier analysis showed that 2-year longevity was worse as the number of malnutrition, inflammation, and stroke factors increased from 0 to 3 in both the GNRI-based model (92% vs 68% vs 46% vs 12%, respectively; P<.001) and the CONUT score model (87% vs 75% vs 49% vs 10%, respectively; P<.001). The hazard ratio between those with 3 factors and those without was 18.2 (95% CI 7.0-47.2; P<.001) in the GNRI and 13.6 (95% CI 5.9-31.5; P<.001) in the CONUT score model. Conclusions: This study demonstrated the association and crucial role of malnutrition, inflammation, and stroke factors in assessing 2-year longevity in older patients with LEAD. Using this simple risk score might assist clinicians in selecting the appropriate treatment.

Original languageEnglish
Article numbere17487
JournalJournal of Medical Internet Research
Volume22
Issue number12
DOIs
StatePublished - 12 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020 Journal of Medical Internet Research. All rights reserved.

Keywords

  • Association rules
  • Clinical informatics
  • Endovascular therapy
  • Longevity
  • Lower extremity arterial disease
  • Medical informatics
  • Octogenarians
  • Older people
  • Prognosis
  • Risk

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